Overview
Benign paroxysmal torticollis of infancy is characterized by recurrent episodes of head tilting to one side, often accompanied by nausea and vomiting, without evidence of structural brain abnormalities. 1Diagnosis
Diagnostic Criteria: Based on clinical presentation with recurrent episodes of head tilting, typically lasting minutes to hours, without neurological deficits. 1
Recommended Tests:
- Audiometry: To rule out hearing abnormalities, typically normal in affected children. 1
- Caloric Test: May show normal responses in most cases but can reveal abnormalities in up to 35% of patients. 1
- Vestibular Evoked Myogenic Potential (VEMP) Test: Abnormal responses noted in about 50% of cases, indicating potential vestibular involvement. 1
Combined Testing: Combining caloric and VEMP tests identifies vestibular abnormalities in 70% of children with benign paroxysmal vertigo, suggesting overlap with basilar type migraine features. 1Management
First-Line Treatments:
- Observation: Often sufficient as symptoms typically remit spontaneously by early childhood. 1
- Symptomatic Relief: Managing nausea and vomiting with antiemetic medications as needed. 1
Adjunctive Treatments:
- Preventive Medications: Not specifically detailed in the provided abstracts; generally, prophylactic treatments are individualized based on symptom severity. 1Special Populations
Pediatrics: The condition predominantly affects infants and young children, with spontaneous resolution often observed by early childhood. 1Key Recommendations
Utilize combined caloric and VEMP testing for a more comprehensive evaluation of vestibular function in children suspected of benign paroxysmal vertigo, highlighting potential similarities with basilar type migraine. (Evidence: Moderate) 1
Initial management should focus on symptomatic relief, particularly for associated nausea and vomiting, with observation as the cornerstone due to the self-limiting nature of the condition. (Evidence: Expert opinion) 1
Consider individualized prophylactic treatment approaches for severe cases, though specific drug recommendations are not detailed in current evidence. (Evidence: Weak) 1References
1 Chang CH, Young YH. Caloric and vestibular evoked myogenic potential tests in evaluating children with benign paroxysmal vertigo. International journal of pediatric otorhinolaryngology 2007. link